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Summer Sessions 2013 Graduate Registration Form

To register, complete this form and click the "SUBMIT" button below, or print out the form and mail it to:

Graduate Studies Office
Clarke University
1550 Clarke Drive
Dubuque, Iowa, 52001-3198

If you have any questions call (563)588-6635.

Last Name:   
First Name:   
Middle:   
Please indicate if you were previously registered at Clarke under a different name.
    Formerly:   

Date of Birth: 
 
 
(The graduate studies office will contact you for your social security number.)

Permanent Home Address
 
    Street:   
    City:   
    State:   
    Zip Code:  

Summer Address 
 
    Street:   
    City:   
    State:   
    Zip Code:   

Send Billing / Grades To:
 
 

Telephone Numbers / Email
 
    Day:   
    Evening:   
    Summer:  
    Email Address:   

I wish to register for the following summer session courses:
(Include beginning / ending dates of courses. Check course descriptions for pre-requisites. Workshops must be registered on the campus offering the workshop.)

    Course One:
      Session Dates
      Synonym Number
      Dept/Course Number
      Section
      Course Title
      Credits

    Course Two:
      Session Dates
      Synonym Number
      Dept/Course Number
      Section
      Course Title
      Credits

    Course Three:
      Session Dates
      Synonym Number
      Dept/Course Number
      Section
      Course Title
      Credits


I am currently a student at:

  College / University

Have you registered for a course at Clarke University before? 
   

I expect to receive veterans' benefits:
   

Clarke University Students: Has your academic advisor and/or chair approved this registration?
   
Other Students: Please submit application and transcripts to Clarke University Graduate Studies Office, 1550 Clarke Drive, Dubuque, Iowa, 52001-3198.

Signature of Registrant:     Date:    

Registration is not official unless student types their name above or signs the printed registration form agreeing to the regulations stated in the summer school schedule.

 
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